Stradasys’ robust and cost-effective software empowers physicians by increasing revenue and boosting overall profitability while elevating payor performance.

Many Physicians Lose Revenue Every Day…
Capriciously changing fee schedules. Arbitrary down-coding. Late payments. Usage of unclear contractual terms and rates. Indiscriminate application of payment rules. These are but a few of the issues that many physician practices state that they routinely encounter.

But true contract performance is often a mystery. Contract variables - such as fee schedules, reimbursement methodologies and non-standardization of payment rules make trending and tracking metrics difficult. Reported actual and/or relative payor revenue is imprecise. Collections and A/R at the payor level is unknown. More importantly, total revenue receipts rarely equate to what was expected. And differentiating payor contribution at the product, CPT-4 code, modifier or place of care is nearly impossible.

Tools and methods for validating payment accuracies have traditionally fallen short. More efficient and meaningful automated systems are often costly and difficult to use. As a result, manually intensive back-end processes, aided by excellent staff memories and individual contract interpretation, are implemented. But the vast number of transactions and contract details makes this infeasible. Accordingly, consistent, reliable methods for verifying and reconciling reimbursement at the specific contract level often go undone. Ultimately, this results in more under-reimbursements and weakness in contracting strategies. And physicians feel out of control.

A Simple Answer to Complex Problems
Stradasys AES provides a simple browser-based view of insurance claims that deviate from agreed-upon reimbursement fee schedules and payment rules. It determines discrepancies by calculating the expected fee and comparing it to the actual reimbursement. An itemized listing of identified under-reimbursed claims, noting the specific amount of the underpayment, is provided at both the payor and provider level. Moreover, the user always has the ability to look at the specific claim detail to review the rationale. Thus, Stradasys equips an office with the tools and information necessary to appeal underpayments.

Additionally, Stradasys organizes and analyzes payor reimbursement from various perspectives. And, as AES is a Medicare payment based system, it even permits you to compare the actual payor reimbursement to the appropriate Medicare reimbursement rate, enabling a more meaningful comparative study of your payors. AES employs the ability to track performance indicators such as collections as compared to either charges or expected reimbursement, promptness of payment and potential silent PPO behavior. Furthermore, in addition to generating payor and product level reports, information is organized by CPT-4 codes, ICD-9’s, market and demographics.

In addition to the payor performance insight provided, Stradasys AES can be used to analyze the current or future profitability of ancillary procedures and lab tests; support capital investment and strategic planning decisions; conduct contract modeling; and support your charge master revisions.

Would you like to learn more about AES? Call us today to schedule a product demonstration.